Association between perceived life chaos and medication adherence in a postmyocardial infarction population.

Abstract

Background

The benefits of medication adherence to control cardiovascular disease (CVD) are well defined, yet multiple studies have identified poor adherence. The influence of life chaos on medication adherence is unknown. Because this is a novel application of an instrument, our preliminary objective was to understand patient factors associated with chaos. The main objective was to evaluate the extent to which an instrument designed to measure life chaos is associated with CVD-medication nonadherence.

Methods and results

Using baseline data from an ongoing randomized trial to improve postmyocardial infarction (MI) management, multivariable logistic regression identified the association between life chaos and CVD-medication nonadherence. Patients had hypertension and a myocardial infarction in the past 3 years (n=406). Nearly 43% reported CVD-medication nonadherence in the past month. In simple linear regression, the following were associated with higher life chaos: medication nonadherence (β=1.86; 95% confidence interval [CI], 0.96-2.76), female sex (β=1.22; 95% CI [0.22-2.24]), minority race (β=1.72; 95% CI [0.78-2.66]), having less than high school education (β=2.05; 95% CI [0.71-3.39]), low health literacy (β=2.06; 95% CI [0.86-3.26]), and inadequate financial status (β=1.93; 95% CI [0.87-3.00]). Being married (β=-2.09, 95% CI [-3.03 to -1.15]) was associated with lower life chaos. As chaos quartile increased, patients exhibited more nonadherence. In logistic regression, adjusting for sex, race, marital status, employment, education, health literacy, and financial status, a 1-unit life chaos increase was associated with a 7% increase (odds ratio, 1.07; 95% CI [1.02-1.12]) in odds of reporting medication nonadherence.

Conclusions

Our results suggest that life chaos may be an important determinant of medication adherence. Life chaos screenings could identify those at risk for nonadherence.

Clinical trial registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT000901277.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1161/circoutcomes.113.000435

Publication Info

Zullig, Leah L, Ryan J Shaw, Matthew J Crowley, Jennifer Lindquist, Steven C Grambow, Eric Peterson, Bimal R Shah, Hayden B Bosworth, et al. (2013). Association between perceived life chaos and medication adherence in a postmyocardial infarction population. Circulation. Cardiovascular quality and outcomes, 6(6). pp. 619–625. 10.1161/circoutcomes.113.000435 Retrieved from https://hdl.handle.net/10161/30029.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Zullig

Leah L Zullig

Professor in Population Health Sciences

Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 150 peer-reviewed publications. 

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research

Shaw

Ryan Shaw

Associate Professor in the School of Nursing

I lead teams that discover how to integrate patient generated health data and emerging technologies into novel care delivery models for patients with complex chronic illnesses. This includes data from wearables, sensors and devices that monitor and augment patient care and interface with electronic health records (EHRs). With these tools I engineer equitable care models that capitalize on the growing digital health infrastructure of health systems and society.

My program of research is funded by the US National Institutes of Health (NIH), as well as previously by the Agency for Healthcare Research and Quality (AHRQ) and the National Science Foundation (NSF), among others.

As the Director of Duke University School of Nursing's Health Innovation Lab, located adjacent to Duke Hospital, I oversee a space for entrepreneurship, product development and testing, as well as modeling and evaluating care delivery processes.

Additionally, I teach classes in health informatics and research methods, and mentor students to become the next generation of health scientists and clinicians.

I currently co-lead two NIH-funded clinical trials:
EXTEND (grant R01NR019594): extend.nursing.duke.edu
Log2lose (grant: U24HL150227): log2lose.com

Crowley

Matthew Janik Crowley

Associate Professor of Medicine

Diabetes, Hypertension, Health Services Research

Shah

Bimal Ramesh Shah

Assistant Consulting Professor in the Department of Medicine
Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy


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